613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

Abstract

BackgroundRupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion.MethodsSystematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011.ResultsWe found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases.The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy.ConclusionsEmergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture.

Spontaneous Splenic Rupture Following Bouts of Coughing: A Rare Case Report and Literature Review

“…There have also been case reports of spontaneous rupture of spleen following colonoscopy, endoscopic retrograde cholangiopancreatography, hepatic and pulmonary surgery and even emission computed tomography, laparoscopy and hysterectomy [4].…”

“…The review article published by Aubrey-Bassler and Sowers [4] mentioned four case reports of spontaneous rupture of spleen following vomiting [1,[17][18][19][20][21][22][23][24][25][26][27][28][29], and one case report following seizure [20]. There have also been case reports of spontaneous rupture of spleen following colonoscopy, endoscopic retrograde cholangiopancreatography, hepatic and pulmonary surgery and even emission computed tomography, laparoscopy and hysterectomy [4].…”

“…There have also been previously undiagnosed non-hematological neoplastic causes of spontaneous rupture of spleen reported; the common causes cited are angiosarcoma, choriocarcinoma, pancreatic cancer, lung cancer, etc. Spontaneous splenic ruptures are also caused by anticoagulation, thrombolytics, recombinant granulocyte-colony stimulating factor, and antiplatelet agents [4].…”

“…It accounts for up to 1% of all splenic ruptures [3]. In a comprehensive review article published in 2012 by AubreyBassler and Sowers [4], there were only 12 reported cases of spontaneous rupture of the normal spleen after coughing in English and French literature on human subjects between 1950 and 2011 [5][6][7][8][9][10][11][12][13][14][15][16].…”

Epidemiology and management of splenic injury: An analysis of a Chinese military registry

“…The majority of patients that present with splenic injury managed by NOM experience adequate recovery, particularly pediatric patients (26,27). This may be due to the development of artery angiography and embolization, and the increasing use of computed tomography (CT) scanning.…”